title: The role of shelf acetabuloplasty in early and late stages of Perthes disease: a meta-analysis of observational studies.
abstract: OBJECTIVE
  Perthes disease may result in deformity of the proximal femoral epiphysis and incongruity of the hip, and shelf acetabuloplasty has been frequently used for treatment. The aim of this study was to review the published articles about the outcome of shelf acetabuloplasty as a containment or reconstruction-salvage procedure in Perthes disease.
  
  
  METHODS
  We utilized the PubMed online database for peer review articles using the following search terms: shelf arthroplasty, acetabuloplasty, and Perthes. To be included in this meta-analysis, we isolated studies on children with Perthes disease who received shelf acetabuloplasty as a treatment, conducted in any geographic location with the Stulberg classification outcome. Twenty articles were identified for a qualitative systematic review. The fixed effect and random effect meta-analysis were performed as appropriate for the summary pool estimate following the heterogeneity test. The meta-analysis was performed on 11 articles in three categories: all articles, articles for shelf arthroplasty in the early stages of Perthes disease, and in the late stages.
  
  
  RESULTS
  Overall, shelf acetabuloplasty provided 84 % good outcome of Stulberg classes I, II, and III. Shelf acetabuloplasty performed in early stages for containment provided good outcome in 85 %, while only 69 % good outcome was achieved when shelf acetabuloplasty was performed in late stages for reconstruction-salvage.
  
  
  CONCLUSIONS
  Shelf acetabuloplasty provides a good or fair Stulberg outcome when performed in early Perthes stages (Waldenström stages I and II) as a containment surgery, but less favorable outcomes were observed when shelf surgery was used for reconstructive-salvage purposes in late Perthes disease stages (Waldenström stages III and IV). Caution is advised in performing the shelf procedure in children over 10-11 years of age.
authors.affiliation: Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: Muayad
authors.initials: M
authors.lastname: Kadhim
authors.forename: Larry
authors.initials: L
authors.lastname: Holmes
authors.forename: J Richard
authors.initials: JR
authors.lastname: Bowen
keywords: Containment; Meta-analysis; Perthes disease; Reconstruction–salvage; Shelf acetabuloplasty